Published in:
Open Access 01-09-2018 | Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
An Overview of Clinical Outcomes in Transvenous and Subcutaneous ICD Patients
Published in: Current Cardiology Reports | Issue 9/2018
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Purpose of Review
Clear guidelines on when to select a subcutaneous ICD (S-ICD) over a transvenous ICD (TV-ICD) are lacking. This review will provide an overview of the most recent clinical data on S-ICD and TV-ICD therapy by pooling comparison studies in order to aid clinical decision making.
Recent Findings
Pooling of observational-matched studies demonstrated an incidence rate ratio (IRR) for device-related complication of 0.90 (95% CI 0.58–1.42) and IRR for lead-related complications of 0.15 (95% CI 0.06–0.39) in favor of S-ICD. The IRR for device infections was 2.00 (95% CI 0.95–4.22) in favor of TV-ICD. Both appropriate shocks (IRR 0.67 (95% CI 0.42–1.06)) and inappropriate shocks (IRR 1.17 (95% CI 0.77–1.79)) did not differ significantly between both groups.
Summary
With randomized data underway, the observational data demonstrate that the S-ICD is associated with reduced lead complications, but this has not yet resulted in a significant reduction in total number of complications compared to TV-ICDs. New technologies are expected to make the S-ICD a more attractive alternative.